The active management of intrahepatic cholestasis of pregnancy

PURPOSE OF REVIEW: To review the literature regarding the active management of intrahepatic cholestasis of pregnancy. RECENT FINDINGS: There has been an increasing trend toward the active management of cholestasis of pregnancy. This trend exists because clinicians have yet to discover adequate solutions to avert the morbidities and mortalities associated with the disorder. It is believed that early intervention by induction of labor before the 38th week of gestation will decrease the incidence of intrauterine fetal demise associated with cholestasis of pregnancy. It is also believed that treating the clinical symptoms of cholestasis with 2-5 ursodeoxycholic acid will improve maternal symptoms, facilitate the prolongation of pregnancy, and possibly improve fetal outcomes. SUMMARY: The current literature encourages the induction of labor between 37-38 weeks' gestation in order to reduce the incidence of stillbirth in women with intrahepatic cholestasis of pregnancy. The most widely used medication for both the treatment of maternal pruritus and the elevations in maternal liver enzymes associated with cholestasis of pregnancy is 2-5 ursodeoxycholic acid. Neither mode of practice has been subjected to randomized clinical trials.